Healthcare Provider Details

I. General information

NPI: 1093255986
Provider Name (Legal Business Name): ROBERT BEATY RCP, RRT-ACCS, AE-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRL
RIVIERA BEACH FL
33410-7417
US

IV. Provider business mailing address

225 HILLVIEW DR
SHELBYVILLE KY
40065-9729
US

V. Phone/Fax

Practice location:
  • Phone: 502-812-8457
  • Fax:
Mailing address:
  • Phone: 502-812-8457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number6060
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number6060
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number6060
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: